As the new Affordable Care Act (ACA) takes hold this month, there’s a lot of confusing news and information swirling around about options, smart choices and next steps. There’s also a fundamental shift taking place in healthcare today, which is the realization that Americans do not comply effectively with direction provided by their physicians or medical practitioners, and often take their prescribed medications improperly if at all.

Part of the reason for this failure is a lack of understanding or the ability to translate complex medical directions into simple, recommended action which is often referred to as “health literacy.” But that’s not the entire problem. People are forgetful, or have a tendency to stop following directions or taking their meds when they’re no longer in crisis or start feeling “better.” The ACA includes money and program guidance for addressing health literacy issues, and is targeting wellness as an important opportunity to help Americans improve their health and help reduce medical costs.

Studies have shown that non-compliance causes 125,000 deaths annually in the United States, leads to 10 percent to 25 percent of hospital and nursing home admissions, and is becoming an international epidemic. The magnitude of this problem is obvious when you consider that 32 million Americans use three or more medicines daily, and that as many as 75 percent of patients (and 50 percent of chronically ill patients) fail to adhere to or comply with physician-prescribed treatment regimens.

The reasons behind this failure are varied, ranging from simple forgetfulness to confusion to ambivalence, but the problem costs an estimated $290 billion in emergency-room visits and other avoidable medical expenses in the United States every year.

What we can each do better

People confront situations that involve life-changing decisions about their health every day. These decisions are made in places such as grocery and drug stores, workplaces, playgrounds, doctors’ offices, clinics and hospitals, and around the kitchen table. Obtaining, communicating, processing, and understanding health information and services are essential steps in making appropriate health decisions; however, research indicates that today’s health information is presented in ways that are not usable by most adults, and people often can’t find and use the health information and services they need.

Without clear information and an understanding of the information’s importance, people are more likely to skip necessary medical tests, end up in the emergency room more often, and have a harder time managing chronic diseases like diabetes or high blood pressure.

Each of us can improve our overall health or the health of those we care for by following these simple steps:

Ask questions. Your physician, nurse, or other medical professional wants you to get better, so don’t be afraid to ask questions. We often remain silent because we don’t understand directions, don’t want to appear dumb, feel like we’re “wasting their time,” or think we can figure it out on our own after we leave the doctor’s office, clinic, hospital or pharmacy. If something isn’t clear, ask about it!

Take your medications as prescribed. Studies show that Americans who take one medicine a day comply up to 75 percent, but with three or more medications daily, that compliance level falls to under 50 percent. Read the directions, leave yourself notes, purchase daily pill dispensers, ask others to remind you, or establish a daily time or other discipline for making sure you remember your meds.

Understand how your meds work. Some medications need to be taken with food, others before you eat. Some are taken in the morning, others before you go to bed. In many cases, you have to be aware of potential reactions when mixing drugs and certain foods, alcohol or behaviors such as driving or working. Read labels and make sure you understand how to use your medications properly.

Don’t stop taking your meds when you start feeling better…unless you’ve been told to stop. Some prescription medications, like antibiotics, require the complete seven- or 10-day dose to ensure your body has fully recovered from an illness or infection. If you stop early because you’re feeling better or dislike potential side effects, you run a high risk of becoming sick again, or infecting others.

Practice conformity with medical recommendations. This is about your health — why go half way? If your doctor suggests walking or changing your diet, reducing alcohol consumption or not smoking, choosing not to comply is as foolish as not taking your prescription medications. It’s often these choices we make that determine our ability to recover and improve our longer-term health and wellness.

Thousands of American women (and hundreds of men) are diagnosed with breast cancer annually. Early detection and treatment are key to treating and containing this disease. Knowing your family history, getting regular exams and avoiding known cancer-causing foods and activities decrease your chances of developing cancer. Additionally, proper diet and exercise, avoiding smoking or using tobacco products, and drinking in moderation can help keep you healthier and reduce the chances of contracting certain types of cancer.

October is Breast Cancer Awareness Month. When detected early before it can spread to other parts of the body, breast cancer can be treated through radiation, drug therapy and surgery, and many cancer survivors live long, healthy lives. If you discover a persistent lump in your breast or any changes in breast tissue, it is very important that you see a physician immediately. Fortunately, eight out of 10 breast lumps are benign, or not cancerous. But women sometimes stay away from medical care because they fear what they might find. Women can take charge of their health by performing routine breast self-exams, establishing ongoing communication with their doctors, and scheduling regular mammograms. Men should speak with their doctor as well if they find suspicious lumps, abnormal skin growths, experience tenderness or experience other changes in their breasts.

For women, a mammogram remains one of the best tools available for the early detection of breast cancer. While women who have a family history of breast cancer are in a higher risk group, most women who have breast cancer have no family history. If you have a mother, daughter, sister or grandmother who had breast cancer, you should have a mammogram five years before the age of their diagnosis, or starting at age 35. Additionally, genetic testing is now getting a lot of attention, especially with high-profile patients like Angelina Jolie, who recently had a precautionary double mastectomy due to genetic profiling that found her at high risk of developing breast cancer. That case has given rise to many questions about genetic testing, its benefits, and ethical considerations that accompany testing and preventive surgeries.

What is genetic testing?

Genetic testing looks for specific inherited changes (mutations) in a person’s chromosomes, genes, or proteins. Genetic mutations can have harmful, beneficial, neutral (no effect), or uncertain effects on health. Mutations that are harmful may increase a person’s chance, or risk, of developing a disease such as cancer. Overall, inherited mutations are thought to play a role in about 5 to 10 percent of all cancers.

Cancer can sometimes appear to “run in families” even if it is not caused by an inherited mutation. For example, a shared environment or lifestyle, such as tobacco use, can cause similar cancers to develop among family members. However, certain patterns such as the types of cancer that develop, other non-cancer conditions that are seen, and the ages at which cancer typically develops may suggest the presence of a hereditary cancer syndrome.

The genetic mutations that cause many of the known hereditary cancer syndromes have been identified, and genetic testing can confirm whether a condition is, indeed, the result of an inherited syndrome. Genetic testing is also done to determine whether family members without obvious illness have inherited the same mutation as a family member who is known to carry a cancer-associated mutation.

Inherited genetic mutations can increase a person’s risk of developing cancer through a variety of mechanisms, depending on the function of the gene. Mutations in genes that control cell growth and the repair of damaged DNA are particularly likely to be associated with increased cancer risk.

What do you need to know about genetically inherited diseases and genetic tests?

Here’s a short list of important facts useful to know concerning genetic mutations and testing:

Genetic mutations play a role in the development of all cancers. Most of these mutations occur during a person’s lifetime, but some mutations, including those that are associated with hereditary cancer syndromes, can be inherited from a person’s parents.

Inherited mutations play a major role in the development of about 5 to 10 percent of all cancers.

The genetic mutations associated with more than 50 hereditary cancer syndromes have been identified, and genetic tests can help tell whether a person from a family with such a syndrome has one of these mutations.

A genetic counselor, doctor, or other healthcare professional trained in genetics can help an individual or family understand genetic test results.

A high genetic likelihood of developing a certain type of cancer is not a certainty that a person will develop that cancer. The risks and benefits of precautionary or preemptive surgeries have to be determined on a case by case basis.

Often, discovering potential genetic mutations may lead a person to alter behaviors, diet and other aspects of health and wellness that can help improve quality of life and health without undertaking dramatic steps.

Autumn in New England is, for many of us, as good as it gets — warm days, crisp evenings, the smell of wood fires, pumpkins and freshly picked apples, breathtakingly colorful, scenic panoramas in every direction…what could be bad? Well, the days are getting shorter, the evenings colder and winter isn’t far away — but let’s stay focused on the positive, okay?

This is a great time of year to be outdoors walking, riding and hiking, working in the yard and enjoying the fresh air and beautiful scenery. As the cooler weather approaches it may portend the limitation of certain outdoor activities, but as is said, “When one door closes, another opens.” In this case, it’s the opportunity to continue our commitment to improved health and fitness, and to plan activities that will prevent us from winter stagnation. That may include many kinds of indoor fitness activities such as aerobic workouts, spinning, dance, yoga, swimming, athletics and much more, but also includes outdoor recreation such as hiking, bicycling and sports that can be practiced until the big chill sets in.

Dressing properly for the cooler weather is critical, as is proper hydration. It’s also important to remember to protect ourselves from damaging ultraviolet rays. However warming and enriching, sunshine damages unprotected skin all year long, and we need to continue using sunscreen and protecting our eyes as well, even in the cooler months.

Autumn also is a good time to moderate our diets, and a chance to implement good nutritional practices that may help reduce the seasonal gluttony (and related guilt) that accompanies the rapidly approaching holidays. Taking the time now to focus on sugar, fat, salt and carbohydrate intake will leave us in far better shape come January!

Walk the walk

One of the simplest and most beneficial outdoor wellness activities is walking. This valuable exercise is good for our hearts, breathing, blood pressure, circulation, cholesterol levels, joint health and much more. If dressed for the weather with clothes that wick or keep moisture off our skin, we can walk all-year-round. And when it comes to fitness value it doesn’t really matter where we walk, as long as it’s done regularly and for long-enough distances and time periods to make a positive health difference.

According to a recent national survey conducted in August 2013 by GfK Research on behalf of Kaiser Permanente, Americans know that walking is good for their overall health, but many are not walking enough to meet recommended guidelines for health benefits. According to the survey, 30 percent of Americans said they walk more than they did five years ago, 35 percent are walking less and 32 percent are walking about the same amount. One-third of those surveyed said they don’t walk for 10 minutes at a time over the course of a week. In addition, 31 percent of those who walk do so for less than 150 minutes per week, which is the minimal threshold for physical activity established by the Centers for Disease Control and Prevention.

Nationwide, 94 percent of those surveyed said they view walking as good for their health and 79 percent acknowledge they should walk more. At least nine in 10 respondents agreed that walking is a good way to lose weight, maintain a healthy weight and can help prevent heart disease. In addition, 73 percent said they believe their children should walk more. Respondents also view walking as a good way to reduce stress and combat depression. More than eight in 10 Americans said walking can reduce feelings of depression and 87 percent said walking helps reduce anxiety.

Survey respondents don’t necessarily view the CDC’s guidelines as difficult to meet. Half said it would not be difficult to meet the CDC’s guidelines of walking 150 minutes per week. Nearly six in 10 respondents also said they would walk more if their doctor told them to.

When asked why they don’t walk more, those surveyed cited lack of time and energy. Not living in communities where they can walk to services, shops, school and work is also a deterrent. Four in 10 describe their neighborhood as “not very” or “not at all walkable.”

So, if we know that walking is good for us, and we know we don’t do it often enough, what can we do to change this paradigm? Setting personal, achievable goals is the first priority.

Walking a minimum of 30 minutes a day, five days a week can help address chronic conditions such as heart disease, diabetes, obesity and depression that limit our quality of life and contribute to the escalating cost of healthcare. Everyone can benefit from walking, regardless of age. It can be done alone, with a partner, or in groups. Depending on where you live, and when you go to school or work, you can establish your own walking routine any time of day or night.

Set simple goals: Plan to walk every day, or at least five days a week, at a time that works best for you. If something interferes with your walking schedule or the weather is lousy, walk later that day or the next day when it’s more convenient. Great walking venues include parks, schools, athletic tracks, established walking trails or your own neighborhood. City streets, shopping malls and quiet, safer roads can suffice, as well. Keep a written or electronic record of your walking so you can track your progress, and reward yourself when you hit a personal milestone of your own choosing. Encourage a friend, child or work associate to join you, and see walking as a critical daily activity, not as elective.

When it comes to improving our health and wellness success often comes a step at a time. Small goals lead to small victories, which lead to additional, often larger victories. We build acceptance and positive results by setting and supporting achievable measures, and our progress results in greater participation and increased resolve.

There are many positive steps employers can take to encourage employees to embrace wellness efforts. It begins, however, with a commitment to try something, however minor, and to see it through. Success, it’s been said, is contagious, proving wellness and contagion can coexist, at least on paper!

Here are some examples of small steps being practiced by two Connecticut employers participating in the CBIA Healthy Connections wellness program.

Jan Wahnon is the wellness champion for The Computer Company, an IT solutions firm located in Cromwell. When it comes to health, every little bit counts, Wahnon says, and sometimes you just have to start out with the basics. Her company offered a reduced gym membership, she explains, but there wasn’t enough interest among the staff. So they looked for some wellness alternatives that were easy to introduce and support.

“Here at The Computer Company,” Wahnon says, “we have monthly company-wide meetings to talk about upcoming business, completed projects, birthdays, and company anniversaries. These meetings finish up with snacks and bagels for everyone. Since starting the wellness program, we have cut down from three birthday cakes to one a month, and have switched the sugary snacks for fruit, vegetables, yogurt, and granola. We find that after the meeting people feel better and don’t feel the need to nap at their desks.”

The company owners, she adds, also held a wellness event tied to a monthly all-staff meeting, and brought in a guest speaker, Dr. Allie Mendelson, DC, from Talcott Family Chiropractic. “Mendelson is a nutritionist and hosts a radio program about healthy living,” cites Wahnon. “She came to our office and spoke about nutrition, holistic health and wellness. My associates and I enjoyed hearing the presentation and learned a lot from it.”

As a related story, Devon Francis, the wellness champion for Fiduciary Investment Advisors (FIA), shared wellness efforts underway at her company, which has 37 employees and is located in Windsor.

“We have a corporate membership at a gym down the street from our office, and the more people that sign up, the less expensive it is for each member,” says Francis. “More than half of our employees are members, and about 10 people regularly go to the gym on their lunch hour or before or after work. We even have a few employees who organized an informal group-fitness class after the regularly scheduled lunchtime class at the gym was canceled. They met with people from other companies in the area and followed the same type of format that the class sponsored by the gym followed.” The class at the gym, she adds, was later reinstated, and remains a popular activity.

Francis’ company designated this past May as “Better Sleep and Mental Health Awareness month.” For the last two weeks of the month, she says, they used an empty office as a “recharge room.” “We set up yoga mats, a noise machine, a comfy chair, a foot massager, and provided magazines and fresh water with lemons and limes,” Francis recalls. “Employees could pay five dollars for a 20-minute break in the relaxation room, and we donated all of the money to tornado relief in Oklahoma. It was a great opportunity for people to step back from the hustle and bustle of the day and take some time to relax and relieve stress.”

FIA also submits relay teams annually for The Hartford Marathon, a company tradition now in its tenth year. This year they’ll sponsor four teams of employees who will each complete a portion of the race. Twelve employees and their families are participating, and they raise funds to donate to CT Children’s Medical Center.

Editor’s Note: Do you have a wellness practice or story you’d like to share? Contact Michelle Molyneux at michelle.molyneux@cbia.com.

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If you’re not enjoying the benefits of a wellness program at your company, join CBIA Healthy Connections at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!